Impact of the Patient-Provider Relationship on the Survival of Foreign Born Outpatients with Tuberculosis

  • Michael Gardam
  • Geetika Verma
  • Ann Campbell
  • Jun Wang
  • Kamran Khan
Original Paper

DOI: 10.1007/s10903-008-9221-8

Cite this article as:
Gardam, M., Verma, G., Campbell, A. et al. J Immigrant Minority Health (2009) 11: 437. doi:10.1007/s10903-008-9221-8

Abstract

Background Managing tuberculosis in foreign born patients entails a complex interaction between patient and provider. Methods Using a retrospective cohort study and survival analysis, this study evaluates the impact of patient and provider factors on the survival of foreign born outpatients with active tuberculosis. The primary outcome of the study is 1 year all-cause mortality. Results In our cohort, patient-provider language discordance was associated with an increased risk of death [HR: 2.33; 95% CI: 1.39–3.88], while receiving treatment from a tuberculosis experienced physician [HR: 0.41; 95% CI: 0.22–0.77] and treatment in a dedicated tuberculosis clinic [HR: 0.53; 95% CI: 0.29–0.98] was associated with a lower risk of death. Discussion Patient-provider communication and health systems factors played a large role in the survival of our cohort of foreign born tuberculosis outpatients. These findings suggest that language barriers and the provision of care by experienced providers in specialized clinic settings may have important effects on health outcomes.

Keywords

TuberculosisMortalitySurvival analysisCommunication barrier

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Michael Gardam
    • 1
    • 2
  • Geetika Verma
    • 3
  • Ann Campbell
    • 1
  • Jun Wang
    • 4
  • Kamran Khan
    • 4
    • 5
  1. 1.Division of Infectious DiseasesUniversity Health NetworkTorontoCanada
  2. 2.Department of Public Health Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada
  3. 3.Department of Medicine, Division of RespirologyUniversity of TorontoTorontoCanada
  4. 4.Centre for Research on Inner City Health, Keenan Research Centre of the Li Ka Shing Knowledge InstituteSt. Michael’s HospitalTorontoCanada
  5. 5.Department of Medicine, Division of Infectious Diseases, St. Michael’s HospitalUniversity of TorontoTorontoCanada